Asthma
Red flags
Consider immediate referral for patients with the following
- Acute exacerbations of asthma showing the following features
- Hypoxia (Pulse oximetry less than 92 mmHg)
- Central cyanosis
- Poor respiratory effort or exhaustion
- PEF less than 33% of predicted
- Hypotension (less than 90mmHg systolic associated with signs of respiratory distress)
- Distress not settling with initial treatment
Other important information for referring practitioners
The aim of asthma management is to control the disease. Complete control is defined as:
- No day or night symptoms
- Minimal or no need for beta agonist treatment (less than 2-3 times/week)
- No exacerbations
- No limitation to physical activity
- Minimal side effects
If control is poor consider:
- Occupational asthma
- Check eosinophils count and IgE level
- Poor compliance and technique
- Triggers
- Smoking
- Medications causing asthma
- Aspirin
- NSAIDs
- Beta blockers
- Eye drops (timolol)
- GORD
- Allergic rhinitis/sinusitis
- Asthma education
- Immunisations
- Influenza vaccine
- Pneumococcal vaccine
- Differential diagnoses
- COPD
- Heart failure
- Hyperventilation
- Inhaled foreign body
- Infection
- Tumours
- Bronchiectasis
- Interstitial lung disease
- Allergic bronchopulmonary aspergillosis
- Aspiration
- Vocal cord dysfunction
Lifestyle factors
- Cease smoking
- Exercise
- 30 mins moderate exercise 5 times weekly
- Advise precautions against exercise induced asthma
- Healthy weight
- Breathing retraining programs
- Yoga
- Physiotherapy led breathing training
General management principles
- Optimise regular use of appropriate dose of preventer
- Usually a combination long acting beta agonist and inhaled steroid
- Choose inhaler device that the patient uses best, including spacer use
- Give patient an asthma action plan
- Ensure patient has a peak flow device for self-monitoring
- Rational treatment plan
- Mild infrequent intermittent asthma
- Use beta agonist prn
- Chronic mild asthma
- Use inhaled corticosteroid
- Short acting beta agonist prn
- Exercise induced asthma
- Use beta agonist 30 mins before exercise
- Intal forte
- Poorly controlled chronic asthma
- Combination long acting beta agonist/low dose corticosteroid inhaler
- Short acting beta agonist prn
- Short term oral steroids for exacerbations
- Poorly controlled moderate asthma
- As above but consider add on:
- High dose inhaled corticosteroid
- Leukotriene antagonist
- Long acting beta agonist
- Short acting beta agonist prn
- As above but consider add on:
- Poorly controlled severe asthma (should be referred to specialist)
- Mild infrequent intermittent asthma
Referral requirements
A referral may be rejected without the following information.
Send referral
Hotline: 1300 364 938
Fax: 1300 364 952
Electronic: eReferral system
Mail: Metro North Central Patient Intake
Aspley Community Centre
776 Zillmere Road
ASPLEY QLD 4034
Health pathways
Access to Health Pathways is free for clinicians in Metro North Brisbane.
For login details email:
healthpathways
Login to Brisbane North Health Pathways:
brisbanenorth.
Locations
Resources
- Named Referral Information Sheet
- Outpatient clinic information
- General referral criteria
- eReferral template